The American College of Radiology (ACR) is finding preliminary reasons for concern about the health care policy ramifications of President Donald Trump’s proposed fiscal year (FY) 2019 budget.

The proposal, released on Feb. 12, features another attempt at rolling back the Patient Protection and Affordable Care Act (Obamacare) and replacing it with a plan that relies on state block grants. It calls for hundreds of billions of dollars in savings through changes to Medicare and Medicaid and for overhauling medical malpractice laws, which the GOP has long argued is necessary for reducing frivolous patient lawsuits and costly defensive medicine.

Though many provisions in the president’s budget are not likely to become law, Congress will explore the merits of some of his administration’s better ideas in detail. The ACR must be prepared to respond if those ideas germinate into tangible legislative proposals.

In particular, the ACR will examine a provision that would expand Medicare's policy on site-neutral payments to require all hospital-owned physician offices located off-campus to be paid the physician office rate. The Office of Management and Budget (OMB) estimates paying hospital-owned doctor practices the same rates as independent practices would save Medicare $34 billion over 10 years.

The ACR has monitored the site neutrality debate for several years while accumulating evidence supporting the assertion that an arbitrary across-the-board cut associated with a strictly interpreted site neutral policy would harm medical imaging reimbursement. The ACR’s data demonstrates that if previous imaging reimbursement policies, such as the Deficit Reduction Act of 2005, are not adequately factored into site neutrality policies, reimbursement for many imaging services would be disproportionally cut more deeply than other physician services.

1 - A $1.4 billion spending increase for National Institutes of Health (NIH) raising its FY 2019 budget to $35.5 billion
2 - $5.8 billion for the Food and Drug Administration including a $473 million increase over current levels and a 17 percent increase in FDA taxpayer funding
3 - Nearly $10 billion in new discretionary funding to fight the opioid epidemic

The ACR will continue reviewing the Trump administration’s FY 2019 budget to determine how its other provisions may affect radiologists and their patients.